<div style="display:block;background-color:#FFF">				
<a href="#mainpage" data-role="button" data-inline="true" data-icon="back">Back</a>
<a href="#mainpage" rel="external" data-role="button" data-inline="true" data-theme="b" data-icon="check">Submit</a>
			
	
	<br/>
						
    	<label><input type="checkbox" name="Option1"/> Elderly 1 </option></label>
        <label><input type="checkbox" name="Option2"/> Elderly 2 </option></label>
        <label><input type="checkbox" name="Option3"/> Elderly 3 </option></label>
        <label><input type="checkbox" name="Option4"/> Elderly 4 </option></label>
        
<a href="#mainpage" data-role="button" data-inline="true" data-icon="back">Back</a>
<a href="#mainpage" rel="external" data-role="button" data-inline="true" data-theme="b" data-icon="check">Submit</a>
			
</div>